Short-term Maternal Complications Research Articles

Health Impacts of Pre-eclampsia: A Comprehensive Analysis of Maternal and Neonatal Outcomes.

Background and Objectives: Hypertensive disorders, particularly pre-eclampsia, pose significant risks during pregnancy, affecting both maternal and neonatal health. The study aims to analyze short- and long-term health implications for mothers and their children, comparing those with pre-eclampsia to those without, to improve understanding of risk factors, diagnostic markers, and outcomes. Materials and Methods: This retrospective observational study involved 235 patients, 98 with pre-eclampsia and 137 without, monitored from 2015 to 2018 at the Obstetrics and Gynecology Department of the "Pius Brînzeu" Emergency County Clinical Hospital in Timișoara, Romania. Results: Women with pre-eclampsia were older, had higher BMIs, and more frequently had a family history of pre-eclampsia, hypertension, and diabetes. They also had lower educational and socioeconomic levels and fewer prenatal visits. Biochemical markers such as higher proteinuria, elevated sFlt-1, and lower PlGF were significant in diagnosing pre-eclampsia. Short-term maternal complications like eclampsia, HELLP syndrome, and acute kidney injury were more prevalent in the pre-eclampsia group. Neonatal outcomes included higher rates of preterm birth, low birth weight, and NICU admissions. Long-term mothers with a history of pre-eclampsia had higher incidences of chronic hypertension, cardiovascular disease, kidney problems, diabetes, and mental health disorders. Their children faced increased risks of neuropsychological delays, chronic respiratory issues, behavioral disorders, learning difficulties, and frequent infections. Conclusions: The study highlights the significant short- and long-term health impacts of pre-eclampsia on both mothers and their children. Early monitoring, intervention, and comprehensive management are crucial in mitigating these risks. These findings underscore the need for personalized care strategies to improve health outcomes for affected individuals.

The association between location of postpartum cervical tear and maternal outcome – a retrospective Study

To determine the associations between the location and characteristics of cervical tears with short-term maternal complications and outcome. This is a retrospective-cohort study. Included were all patients that delivered vaginally at our institute between the years 2009-2020, and diagnosed with a cervical tear. Maternal complications were compared between cases with posterior cervical tear and cases with anterior or lateral cervical tears. Exclusion criteria included patients who delivered by cesarean delivery and preterm labor (below 37.0 weeks of gestation). Overall, 96 patients were diagnosed with posterior cervical tear while 117 patients were diagnosed with anterior/ lateral tear. Maternal demographics and pregnancy characteristics were similar between the groups. There were also no differences in delivery outcomes between the groups. Patients with posterior cervical tears had higher rate of disseminated intravascular coagulation (DIC) (6.25% vs. 0.9%, p=0.04), and prolonged hospitalization (35.4% vs. 23.1%, p=0.05), as compared to patients with anterior/ lateral tears. There were no differences in other maternal complications. Cases of posterior cervical tear are at higher risk for maternal adverse outcome (DIC and prolonged hospitalization), as compared to cases of anterior/ lateral tears.

Cesarean section: to be or not to be, is this the question?

Dear Editor,In the third millennium, there is a new ‘‘trend’’ of delivery:cesarean section (CS).Why the increasing rate? First of all, the delayedchildbearing, the second, safer anesthesia, and third, themedical litigation.The women, today, choose to get pregnant at an olderage in comparison to the XX century. What women want?Obviously, the women want one healthy newborn; thus,they do not accept to have a malformed fetus, an abortionor a complication through the vaginal delivery. However,medicine and obstetrics, in particular, are not exact sci-ences; in fact, complications (which may even be lethal)for the fetus and pregnant woman may occur, even in asmall percentage of cases, in spite of scrupulous manage-ment of pregnancy and labor.In Italy, about 38 % of women deliver by CS withhighest rate in the south of Italy (about 60 % in Campania).WHO in 1980 stated that 10 % of CS was the gold stan-dard, but now this rate is too low and is not achievable inthe third millennium.Recently, a Swedish study [1] demonstrated that twodecades after one birth, vaginal delivery was associatedwith a 67 % increased risk of urinary incontinence (UI),and UI[10 years increased by 275 % compared withcesarean section. Nowadays, an increasing number ofwomen request CS for non-medical indications, and forsome this demand appears to be motivated by a desire toprevent pelvic floor damage, including UI.A CS: is it always safe? Complications that are relatedto CS are increased risk of infections, transfusion, andprolonged hospitalization. CS gets maternal and fetalrisks. Maternal risk may be dangerous such as pulmonaryemboly. The fetal risks regard the procedure itself such as3.12 % accidental fetal lacerations per CS [2]. Recently,Arikan et al. [3] compared maternal and perinatal mor-tality and short-term outcomes of maternal and perinatalhealth between a CS group with relative indications and avaginal delivery group. Maternal morbidity was signifi-cantly lower in the vaginal birth group than the CS group(7 vs 30, p\0.05). Perinatal mortality and perinatalmorbidity were not significantly different between the twogroups. Newborns with the first minute Apgar scorebelow 7 were higher in the CS group (p\0.05). The fifthminute Apgar scores and umbilical cord pH values weresimilar. The authors concluded that short-term maternalcomplications were more frequently seen in cesareandeliveries with relative indications than spontaneousvaginal deliveries. Furthermore, a recent cochrane data-base systematic review [4] assessed the effects of a policyof planned immediate cesarean delivery versus plannedvaginal birth for women in preterm labour and concludedthat there is not enough evidence to evaluate the use of apolicy of planned immediate cesarean delivery for pre-term babies.The last but not the least: medical litigation is increasingin all the world. In some countries, no medical doctor wantto be obstetrician for the fear of medical litigation andbecause the medical insurance do not cover the obstetri-cian, especially if the obstetrician had a previous compli-cation during delivery and relative compliant.

Episiotomies During Deliveries of Singletons in Cephalic Presentation: The Incidence can be Reduced

To verify if episiotomy rate could be reduced without compromising materno-fetal well-being. This retrospective study was conducted between January 1 and December 31, 2010 in the maternity unit of the University Teaching Hospital Yaoundé (Cameroon). All cases of singletons in cephalic presentation with episiotomies done or not done during deliveries were recruited. Data were analyzed by means of SPSS 12.0. The Fisher's exact test was used for comparison. The level of significance was 0.05. We performed 163 episiotomies (9.6%). Main indications were rigid perineum, fetal weight ≥3,500g, prolonged second stage of labor, and instrumental deliveries; 82.2% of patients were nullipara. Mean 5th minute Apgar score was 9.2. Short term maternal complications were mainly perineal pain. Among fetuses delivered with or without episiotomy, no case of early neonatal death was recorded. The use of episiotomy can be reduced without increasing maternal and fetal morbidities.